Emergency Advance Refill Notification Act of 2020

I 116TH CONGRESS 2D SESSION H. R. 6411 To amend the Employee Retirement Income Security Act of 1974, title XXVII of the Public Health Service Act, and the Internal Revenue Code of 1986 to require group health plans and health insurance issuers offering group or individual health insurance coverage to provide notices relating to prescription drug refills to individuals covered under such plans or coverage who reside in emergency areas during emergency peri- ods. IN THE HOUSE OF REPRESENTATIVES MARCH 27, 2020 Mrs. MCBATH (for herself and Ms. KUSTER of New Hampshire) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Education and Labor, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned A BILL To amend the Employee Retirement Income Security Act of 1974, title XXVII of the Public Health Service Act, and the Internal Revenue Code of 1986 to require group health plans and health insurance issuers offering group or individual health insurance coverage to provide notices relating to prescription drug refills to individuals covered under such plans or coverage who reside in emergency areas during emergency periods. VerDate Sep 11 2014 03:54 Apr 15, 2020 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6652 E:\BILLS\H6411.IH H6411 SSpencer on DSKBBXCHB2PROD with BILLS 2 •HR 6411 IH Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Emergency Advance 4 Refill Notification Act of 2020’’. 5 SEC. 2. REQUIRING PRESCRIPTION DRUG REFILL NOTIFI- 6 CATIONS DURING EMERGENCIES. 7 (a) ERISA.— 8 (1) IN GENERAL.—Subpart B of part 7 of sub- 9 title B of title I of the Employee Retirement Income 10 Security Act of 1974 (29 U.S.C. 1185 et seq.) is 11 amended by adding at the end the following new sec- 12 tion: 13 ‘‘SEC. 716. PROVISION OF PRESCRIPTION DRUG REFILL NO- 14 TIFICATIONS DURING EMERGENCIES. 15 ‘‘(a) IN GENERAL.—A group health plan, and a 16 health insurance issuer offering health insurance coverage 17 in connection with a group health plan, that provides bene- 18 fits for prescription drugs under such plan or such cov- 19 erage shall provide to each participant or beneficiary 20 under such plan or such coverage who resides in an emer- 21 gency area during an emergency period— 22 ‘‘(1) not later than 5 business days after the 23 date of the beginning of such period with respect to 24 such area (or, the case of the emergency period de- 25 VerDate Sep 11 2014 03:54 Apr 15, 2020 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H6411.IH H6411 SSpencer on DSKBBXCHB2PROD with BILLS 3 •HR 6411 IH scribed in section 2(d)(2) of the Emergency Advance 1 Refill Notification Act of 2020, not later than 5 2 business days after the date of the enactment of this 3 section), a notification (written in a manner that is 4 clear and understandable to the average participant 5 or beneficiary)— 6 ‘‘(A) of whether such plan or coverage will 7 waive, during such period with respect to such 8 a participant or beneficiary, any time restric- 9 tions under such plan or coverage on any au- 10 thorized refills for such drugs to enable such re- 11 fills in advance of when such refills would oth- 12 erwise have been permitted under such plan or 13 coverage; and 14 ‘‘(B) in the case that such plan or coverage 15 will waive such restrictions during such period 16 with respect to such a participant or bene- 17 ficiary, that contains information on how such 18 a participant or beneficiary may obtain such a 19 refill; and 20 ‘‘(2) in the case such plan or coverage elects to 21 so waive such restrictions during such period with 22 respect to such a participant or beneficiary after the 23 notification described in paragraph (1) has been pro- 24 vided with respect to such period, not later than 5 25 VerDate Sep 11 2014 03:54 Apr 15, 2020 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H6411.IH H6411 SSpencer on DSKBBXCHB2PROD with BILLS 4 •HR 6411 IH business days after such election, a notification of 1 such election that contains the information described 2 in subparagraph (B) of such paragraph. 3 ‘‘(b) EMERGENCY AREA; EMERGENCY PERIOD.—For 4 purposes of this section, an ‘emergency area’ is a geo- 5 graphical area in which, and an ‘emergency period’ is the 6 period during which, there exists— 7 ‘‘(1) an emergency or disaster declared by the 8 President pursuant to the National Emergencies Act 9 or the Robert T. Stafford Disaster Relief and Emer- 10 gency Assistance Act; and 11 ‘‘(2) a public health emergency declared by the 12 Secretary pursuant to section 319 of the Public 13 Health Service Act.’’. 14 (2) CLERICAL AMENDMENT.—The table of con- 15 tents of the Employee Retirement Income Security 16 Act of 1974 is amended by inserting after the item 17 relating to section 714 the following: 18 ‘‘Sec. 715. Additional market reforms. ‘‘Sec. 716. Provision of prescription drug refill notifications during emer- gencies.’’. (b) PHSA.—Subpart II of part A of title XXVII of 19 the Public Health Service Act (42 U.S.C. 300gg–11 et 20 seq.) is amended by adding at the end the following new 21 section: 22 VerDate Sep 11 2014 03:54 Apr 15, 2020 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H6411.IH H6411 SSpencer on DSKBBXCHB2PROD with BILLS 5 •HR 6411 IH ‘‘SEC. 2730. PROVISION OF PRESCRIPTION DRUG REFILL 1 NOTIFICATIONS DURING EMERGENCIES. 2 ‘‘(a) IN GENERAL.—A group health plan, and a 3 health insurance issuer offering group or individual health 4 insurance coverage, that provides benefits for prescription 5 drugs under such plan or such coverage shall provide to 6 each participant, beneficiary, or enrollee enrolled under 7 such plan or such coverage who resides in an emergency 8 area during an emergency period— 9 ‘‘(1) not later than 5 business days after the 10 date of the beginning of such period with respect to 11 such area (or, the case of the emergency period de- 12 scribed in section 2(d)(2) of the Emergency Advance 13 Refill Notification Act of 2020, not later than 5 14 business days after the date of the enactment of this 15 section), a notification (written in a manner that is 16 clear and understandable to the average participant, 17 beneficiary, or enrollee)— 18 ‘‘(A) of whether such plan or coverage will 19 waive, during such period with respect to such 20 a participant, beneficiary, or enrollee, any time 21 restrictions under such plan or coverage on any 22 authorized refills for such drugs to enable such 23 refills in advance of when such refills would 24 otherwise have been permitted under such plan 25 or coverage; and 26 VerDate Sep 11 2014 03:54 Apr 15, 2020 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H6411.IH H6411 SSpencer on DSKBBXCHB2PROD with BILLS 6 •HR 6411 IH ‘‘(B) in the case that such plan or coverage 1 will waive such restrictions during such period 2 with respect to such a participant, beneficiary, 3 or enrollee, that contains information on how 4 such a participant, beneficiary, or enrollee may 5 obtain such a refill; and 6 ‘‘(2) in the case such plan or coverage elects to 7 so waive such restrictions during such period with 8 respect to such a participant, beneficiary, or enrollee 9 after the notification described in paragraph (1) has 10 been provided with respect to such period, not later 11 than 5 business days after such election, a notifica- 12 tion of such election that contains the information 13 described in subparagraph (B) of such paragraph. 14 ‘‘(b) EMERGENCY AREA; EMERGENCY PERIOD.—For 15 purposes of this section, an ‘emergency area’ is a geo- 16 graphical area in which, and an ‘emergency period’ is the 17 period during which, there exists— 18 ‘‘(1) an emergency or disaster declared by the 19 President pursuant to the National Emergencies Act 20 or the Robert T. Stafford Disaster Relief and Emer- 21 gency Assistance Act; and 22 ‘‘(2) a public health emergency declared by the 23 Secretary pursuant to section 319.’’. 24 (c) IRC.— 25 VerDate Sep 11 2014 03:54 Apr 15, 2020 Jkt 099200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H6411.IH H6411 SSpencer on DSKBBXCHB2PROD with BILLS 7 •HR 6411 IH (1) IN GENERAL.—Subchapter B of chapter 1 100 of the Internal Revenue Code of 1986 is amend- 2 ed by adding at the end the following new section: 3 ‘‘SEC. 9816. PROVISION OF PRESCRIPTION DRUG REFILL 4 NOTIFICATIONS DURING EMERGENCIES. 5 ‘‘(a) IN GENERAL.—A group health plan that pro- 6 vides benefits for prescription drugs under such plan shall 7 provide to each participant or beneficiary enrolled under 8 such plan who resides in an emergency area during an 9 emergency period, not later than 5 business days after the 10 date of the beginning of such period with respect to such 11 area (or, the case of the emergency period described in 12 section 2(d)(2) of the Emergency Advance Refill Notifica- 13 tion Act of 2020, not later than 5 business days after the 14 date of the enactment of this section)— 15 ‘‘(1) a notification (written in a manner that is 16 clear and understandable to the average participant 17 or beneficiary)— 18 ‘‘(A) of whether such plan will waive, dur- 19 ing such period with respect to such a partici- 20 pant or beneficiary, any time restrictions under 21 such plan on any authorized refills for such 22 drugs to enable such refills in advance of when 23 such refills would otherwise have been per- 24 mitted under such plan; and 25 VerDate Sep 11 2014 03:54 Apr 15, 2020 Jkt 099200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H6411.IH H6411 SSpencer on DSKBBXCHB2PROD with BILLS 8 •HR 6411 IH ‘‘(B) in the case that such plan will waive 1 such restrictions during such period with re- 2 spect to such a participant or beneficiary, that 3 contains information on how such a participant 4 or beneficiary may obtain such a refill; and 5 ‘‘(2) in the case such plan elects to so waive 6 such restrictions during such period with respect to 7 such a participant or beneficiary after the notifica- 8 tion described in paragraph (1) has been provided 9 with respect to such period, not later than 5 busi- 10 ness days after such election, a notification of such 11 election that contains the information described in 12 subparagraph (B) of such paragraph. 13 ‘‘(b) EMERGENCY AREA; EMERGENCY PERIOD.—For 14 purposes of this section, an ‘emergency area’ is a geo- 15 graphical area in which, and an ‘emergency period’ is the 16 period during which, there exists— 17 ‘‘(1) an emergency or disaster declared by the 18 President pursuant to the National Emergencies Act 19 or the Robert T. Stafford Disaster Relief and Emer- 20 gency Assistance Act; and 21 ‘‘(2) a public health emergency declared by the 22 Secretary pursuant to section 319 of the Public 23 Health Service Act.’’. 24 VerDate Sep 11 2014 03:54 Apr 15, 2020 Jkt 099200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H6411.IH H6411 SSpencer on DSKBBXCHB2PROD with BILLS 9 •HR 6411 IH (2) CLERICAL AMENDMENT.—The table of sec- 1 tions for subchapter B of chapter 100 of the Inter- 2 nal Revenue Code of 1986 is amended by adding at 3 the end the following new item: 4 ‘‘Sec. 9816. Provision of prescription drug refill notifications during emer- gencies.’’. (d) EFFECTIVE DATE.—The amendments made by 5 this section shall apply with respect to— 6 (1) emergency periods beginning on or after the 7 date of the enactment of this Act; and 8 (2) the emergency period relating to the public 9 health emergency declared by the Secretary of 10 Health and Human Services pursuant to section 319 11 of the Public Health Service Act on January 31, 12 2020, entitled ‘‘Determination that a Public Health 13 Emergency Exists Nationwide as the Result of the 14 2019 Novel Coronavirus’’. 15 Æ VerDate Sep 11 2014 03:54 Apr 15, 2020 Jkt 099200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6301 E:\BILLS\H6411.IH H6411 SSpencer on DSKBBXCHB2PROD with BILLS